
<?php  ?>
<div class="row-fluid">
 <div class="span12 pad_all">
 <?php echo form_open(current_url());?>
 
     <div class="span4">
			  <h4 align="center" class="heading">CUSTOMER INFORMATION</h4>
			  <label>Service No.</label>
			  <?php echo form_input($case_id);?>
			  <label>Choose Date</label>
			  <div id="datepicker" class="input-append">
				<?php echo form_input($case_date);?>
					<span class="add-on"id="dat">
					   <i class="icon-calendar"> </i>
				   </span>
			 </div>
			<label>Customer Company Name:</label>
			<?php echo form_input($customer_company);?>
			<span class="text-error"><?= form_error('customer_company'); ?></span>
			<label>Customer Name</label>
			<?php echo form_input($customer_name);?>
			<span class="text-error"><?= form_error('customer_name'); ?></span>
			<label> Address </label>
			<?php echo form_textarea($customer_address);?>
			<span class="text-error"><?= form_error('customer_address'); ?></span>
			<label>PIN Code</label>
			<?php echo form_input($customer_pincode);?>
			<span class="text-error"><?= form_error('customer_pincode'); ?></span>
			<label>Landline Number</label>
			<?php echo form_input($customer_landline);?>
			<span class="text-error"><?= form_error('customer_landline'); ?></span>
			<label>Mobile No.</label>
			<?php echo form_input($customer_mobile);?>
			<span class="text-error"><?= form_error('customer_mobile'); ?></span>
			<label>Email-ID </label>
			<?php echo form_input($customer_email);?>
			<span class="text-error"><?= form_error('customer_email'); ?></span>
      </div>
	  <div class="span4">
			<h4 align="center"class="heading">INFORMATION BY ENGINEER</h4>
			<label>Model No.</label>
			<?php echo form_input($model_no);?>
			<span class="text-error"><?= form_error('model_no'); ?></span>
			<label>Product No.</label>
			<?php echo form_input($product_no);?>
			<span class="text-error"><?= form_error('product_no'); ?></span>
			 <label>Serial No.</label>
			<?php echo form_input($serial_no);?>
			<span class="text-error"><?= form_error('serial_no'); ?></span>
			 <label>Password</label>
			<?php echo form_input($customer_password);?>
			<span class="text-error"><?= form_error('customer_password'); ?></span>
			 <label>Operating System</label>
			<?php echo form_input($customer_os);?>
			<span class="text-error"><?= form_error('customer_os'); ?></span>
			 <label>Country Of Purchase</label>
			   <?php 
	 	     $bl[0] = "";
	   		foreach($country_purch as $row){
				$bl[$row->id] = $row->name;
			}
			echo form_dropdown('country_purchase', $bl, $purchase_country, 'class="chzn-select span12" data-placeholder="Choose a Supplier" style="width:220px;"');  ?>
	                                                                        
			
              <span class="text-error"><?= form_error('country_purch'); ?></span>
		    <label> Issue Reported</label>
		    <?php echo form_textarea($issue_reported);?>
		    <span class="text-error"><?= form_error('issue_reported'); ?></span>
		    <label> Demo Engineer Diagnosis</label>
		    <?php echo form_textarea($enginer_diagnosis);?>
		   <span class="text-error"><?= form_error('enginer_diagnosis'); ?></span>
      </div>
	  <div class="span4">
			<h4 align="center" class="heading">CUSTOMER ACCESSORIES</h4>
			<div class="span5"><h4> Items </h4><hr></div><div class="span6"><h4>Description</h4><hr></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($ac_adapter);?>AC Adapter</label></div>
			 <div class="span6"><?php echo form_input($adapter_detail);?> </div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($driver_cd);?> Driver CD</label></div>
			 <div class="span6"><?php echo form_input($driver_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($bag);?> Bag</label></div>
			 <div class="span6"><?php echo form_input($bag_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($hdd);?> HDD</label></div>
			 <div class="span6"><?php echo form_input($hdd_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($power_cord);?> Power Cord</label></div>
			 <div class="span6"><?php echo form_input($powercord_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($carrycase);?>Carry Case Belt</label></div>
			 <div class="span6"><?php echo form_input($carrycase_detail);?></div>
			  <div class="span5"><label class="checkbox"><?php echo form_checkbox($optical_drive);?>Optical Drive</label></div>
			 <div class="span6"><?php echo form_input($optical_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($modem_card);?>Fax Modem Card</label></div>
			 <div class="span6"><?php echo form_input($modem_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($network_card);?>Network Card</label></div>
			 <div class="span6"><?php echo form_input($network_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($memory);?>Memory</label></div>
			 <div class="span6"><?php echo form_input($memory_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($capacity);?>Capacity</label></div>
			 <div class="span6"><?php echo form_input($capacity_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($tray);?>Tray</label></div>
			 <div class="span6"><?php echo form_input($tray_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($battery_no);?>Battery</label></div>
			 <div class="span6"><?php echo form_input($battery_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($cradle);?>Cradle</label></div>
			 <div class="span6"><?php echo form_input($cradle_detail);?> </div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($fdd);?>FDD</label></div>
			 <div class="span6"><?php echo form_input($fdd_detail);?> </div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($itb);?>ITB</label></div>
			 <div class="span6"><?php echo form_input($itb_detail);?></div>
			 <div class="span5"><label class="checkbox"><?php echo form_checkbox($wireless_lan);?>Wireless LAN</label></div>
			 <div class="span6"><?php echo form_input($wireless_detail);?></div>
		 </div>
		 </div></div>
		 <div class="row-fluid">
		 <h4 align="center"class="heading"> MISCELLANEOUS COMMENTS:</h4>
		 <div class="span4"><label> Scratches</label>	<?php echo form_textarea($comment_scratches);?>    </div> <div class="span4"> <label> Damages</label>	<?php echo form_textarea($comment_damages);?> </div> <div class="span3"> <label> Others</label>	<?php echo form_textarea($comment_other);?></div>
		 
         <div class="span5"></div><div class="span3"><input type="submit" class="btn btn-success " value="Update" id="caseSubmit"/></form>	</div><div class="span3"> </div>	</div>
<script>
 $(document).ready(function() { 
  $('#date').datepicker();
	 format: 'yyyy-mm-dd'
});
</script>
<script>
$(document).ready(function(){
	$('#ac_adapter').is(':checked') ? $("#adapter").show() : $("#adapter").hide();
	$('#ac_adapter').click(function () { $("#adapter").toggle(this.checked);});
	
	$('#driver_cd').is(':checked') ? $("#drivercd").show() : $("#drivercd").hide();
	 $('#driver_cd').click(function () { $("#drivercd").toggle(this.checked);});
	
	$('#cus_bag').is(':checked') ? $("#bag").show() : $("#bag").hide();
	 $('#cus_bag').click(function () { $("#bag").toggle(this.checked);});
	
	$('#cus_hdd').is(':checked') ? $("#hdd").show() : $("#hdd").hide();
	 $('#cus_hdd').click(function () { $("#hdd").toggle(this.checked);});
	
	$('#power_cord').is(':checked') ? $("#power_cordt").show() : $("#power_cordt").hide();
	 $('#power_cord').click(function () { $("#power_cordt").toggle(this.checked);});
	
	$('#cus_carrycase').is(':checked') ? $("#carry_case").show() : $("#carry_case").hide();
	 $('#cus_carrycase').click(function () { $("#carry_case").toggle(this.checked);});
	
	$('#optical_drive').is(':checked') ? $("#optical_drivet").show() : $("#optical_drivet").hide();
	 $('#optical_drive').click(function () { $("#optical_drivet").toggle(this.checked);});
	
	$('#modem_card').is(':checked') ? $("#fax_modem").show() : $("#fax_modem").hide();
	 $('#modem_card').click(function () { $("#fax_modem").toggle(this.checked);});
	
	$('#network_card').is(':checked') ? $("#network_cardt").show() : $("#network_cardt").hide();
	 $('#network_card').click(function () { $("#network_cardt").toggle(this.checked);});
	
	$('#cus_memory').is(':checked') ? $("#memory").show() : $("#memory").hide();
	 $('#cus_memory').click(function () { $("#memory").toggle(this.checked);});
	
	$('#cus_capacity').is(':checked') ? $("#capacity").show() : $("#capacity").hide();
	 $('#cus_capacity').click(function () { $("#capacity").toggle(this.checked);});
	
	$('#cus_tray').is(':checked') ? $("#tray").show() : $("#tray").hide();
	 $('#cus_tray').click(function () { $("#tray").toggle(this.checked);});
	
	$('#battery_no').is(':checked') ? $("#battery").show() : $("#battery").hide();
	 $('#battery_no').click(function () { $("#battery").toggle(this.checked);});
	
	$('#cus_cradle').is(':checked') ? $("#cradle").show() : $("#cradle").hide();
	 $('#cus_cradle').click(function () { $("#cradle").toggle(this.checked);});
	
	$('#cus_fdd').is(':checked') ? $("#fdd").show() : $("#fdd").hide();
	 $('#cus_fdd').click(function () { $("#fdd").toggle(this.checked);});
	
	$('#cus_itb').is(':checked') ? $("#itb").show() : $("#itb").hide();
	 $('#cus_itb').click(function () { $("#itb").toggle(this.checked);});
	
	$('#wireless_lan').is(':checked') ? $("#wireless").show() : $("#wireless").hide();
	 $('#wireless_lan').click(function () { $("#wireless").toggle(this.checked);});
	});
</script>